ArticleRadiation oncology (London, England)2018
Sacral insufficiency fractures after high-dose carbon-ion based radiotherapy of sacral chordomas.
Article in Radiation oncology (London, England), 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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Who cites it
11 citing papers in PubMed.
- Clinical and 18F-FDG PET/CT Imaging Characteristics of Post-radiotherapy Sacral Insufficiency Fractures in Cervical Cancer Patients.Current medical imaging · 2026Article
- Detection of vertebral insufficiency fractures onRadiology case reports · 2025Article
- Carbon Ion and Proton Therapy in Sacral Chordoma: A Systematic Review.Journal of clinical medicine · 2025Review
- Insufficiency fractures in patients with sacral chordoma treated with high-dose radiation therapy with and without resection.BJR open · 2025Article
- Intensity Modulated Carbon Ion Radiation Therapy Using Pencil Beam Scanning Technology for Patients With Unresectable Sacrococcygeal Chordoma.Advances in radiation oncology · 2024Article
- Review
- Sacral insufficiency fracture: a single-center experience of 185 patients with a minimum 5-year follow-up.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2024Article
- Radiotherapy for Mobile Spine and Sacral Chordoma: A Critical Review and Practical Guide from the Spine Tumor Academy.Cancers · 2023Review
- Clinical and MRI features of sacral insufficiency fractures after radiotherapy in patients with cervical cancer.BMC women's health · 2022Article
- High-dose carbon-ion based radiotherapy of primary and recurrent sacrococcygeal chordomas: long-term clinical results of a single particle therapy center.Radiation oncology (London, England) · 2020Article
- Sacral Insufficiency Fractures: a Review of Risk Factors, Clinical Presentation, and Management.Current pain and headache reports · 2020Review
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9 authors.
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Abstract
backgroundThis study aimed to analyse the frequency and clinical relevance of sacral insufficiency fractures (SIFs) after high-dose carbon-ion based irradiation of sacral chordomas.
methodsA total of 56 patients were included in this retrospective study. Twenty one patients (37%) were treated with definitive radiotherapy (RT), and 35 patients (63%) received postoperative RT using carbon ions, either in combination with photons or as single-modality treatment (median radiation dose 66 Gy RBE, range 60-74 Gy). Follow-up examinations including MRI of the pelvis were performed at 3-monthly intervals in the first year and consecutively at 6-monthly intervals. Median follow-up was 35.5 months (range 2-83).
resultsSIFs were diagnosed in 29 patients (52%) after a median follow-up of 11 months (range 1-62 months). Most sacral fractures (79%) occurred within 2 years after RT. For the overall study population, the fracture-free survival probability amounted to values of 0.68 (95% CI, 0.53-0.79) after 1 year, 0.46 (95% CI, 0.31-0.60) after 2 years, and 0.31 (95% CI, 0.16-0.47) after 5 years. Statistical analysis showed no significant difference regarding the fracture rates between patients who received an operation and postoperative RT and patients treated with definitive RT. About one third of the patients with SIFs (34%; 10 of 29 patients) had associated clinical symptoms, most notably pain. All patients with symptomatic fractures required strong analgesics and often intensive pain management.
conclusionsSacral fractures after high-dose carbon ion-based RT of sacral chordomas were shown to be a considerable radiogenic late effect, affecting about half of the treated patients. However, only one third of these fractures were clinically symptomatic requiring regular medical care and pain therapy. Further hazard factor analysis in the future with larger patient numbers will possibly enable the identification of high-risk patients for developing SIFs with the ultimate goal to prevent symptomatic fractures.
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